PAG/RRP/DDF 2–ENG NOV/10 UNIVERSITY OF PUERTO RICO RIO PIEDRAS CAMPUS FINANCE OFFICE DIRECT DEPOSIT FORM FOR SUPPLIERS SECTION 1 (TO BE COMPLETED BY SUPPLIER) Supplier’s name: Social security number: Phone number: Work: Mobile: Fax: Postal address: E-mail address: I hereby authorize the University of Puerto Rico, Río Piedras Campus, to verify and/or send this document to my financial institution for certification of the information included on it. Also, I agree that payments of invoices on behalf of the company/person stated above shall be made by direct deposit to the checking or saving account indicated below. I understand that transactions through the Account Clearing House (ACH) are subject to federal regulations. I am responsible for notifying the University of Puerto Rico, Rio Piedras Campus, of any address or account change in order to remain qualified for the direct deposit payment method, and to continue receiving information from the institution regarding same. The University of Puerto Rico, Río Piedras Campus, reserves the right to accept, deny or cancel the direct deposit payment service. Any request for cancellation of service from the supplier company/person must be received, in writing, at the Finance Office of the Río Piedras Campus, at least thirty (30) days before the cancelation date. In case the aforementioned supplier should receive an incorrect payment in the account indicated below, I authorize the bank to debit this account as a corrective action. Nevertheless, I shall return funds of incorrect payments should the bank’s corrective action not succeed. I authorize and request the payment of invoices, made on behalf my company and/or person be deposited on the following account number: Savings Checking Route or Transit Number On Bank or Financial Institution Branch: (Name) This request form should sign and send to: University of Puerto Rico Río Piedras Campus Finance Office PO Box 23308 San Juan PR 00931-3308 Once the direct deposit payment method begins, any claim for deposited payments on account should be made to the Pre-Audit Division of the University of Puerto Rico, Río Piedras Campus. Print or type name: _______________________________ Signature: ________________________________ Date: ______________________ SECTION 2(TO BE COMPLETED BY FINANCIAL INSTITUTION) Name of financial institution Route number: Address Depositor account title: FINANCIAL INSTITUTION CERTIFICATION I confirm the identity of the above-named payee(s) and the account number and title. As representative of the above-named financial institution, I certify that the financial institution agrees to receive and deposit the payment above in accordance with state and federal rules. Print or type Representative’s name Signature of Representative Telephone Number THE FINANCIAL INSTITUTION SHOULD MAIL THE COMPLETED FORM TO THE GOVERNMENT AGENCY IDENTIFIED ABOVE. SUPPLIERS SHOULD FOLLOW INSTRUCTIONS ON THE OTHER SIDE OF THIS DOCUMENT. Date DIRECT DEPOSIT SERVICE FOR SUPPLIERS OF THE UNIVERSITY OF PUERTO RICO, RIO PIEDRAS CAMPUS Instructions: 1. This form must be completed by typing or printing the information requested on it. 2. Supplier’s responsibilities: a. Submit original form with Section 1, completed and signed to the Finance Office of Río Piedras Campus located at Plaza Universitaria Building, Third Floor, Central Tower at Ponce de León Ave., or send it to the following address: University of Puerto Rico Río Piedras Campus Finance Office PO Box 23308 San Juan PR 00931-3308 b. c. d. e. Keep a copy of the completed form for your records. Notify the Finance Office of UPR Rio Piedras Campus in writing of any changes in the address or bank account . Any changes to the bank account require the completion of a new direct deposit form. All subsequent payments will be made by check until the completion of the required bank re-certifications and pre-notifications. If the change is related to your contact information, as for example address, you can send a written notification to the above address. Return any funds resulting from any incorrect payment deposited in the account, that hasn’t been debited by the bank institution as a corrective action. Submit any request for cancellation of services by writing to the Finance Office of the UPR Río Piedras Campus at least thirty (30) days before the requested cancelation date. Benefits: 1. Invoice payments can be deposited in accounts of the financial institutions of the “Automated Clearing House” system of Puerto Rico: Banco Popular de Puerto Rico Banco Bilbao Vizcaya Oriental Savings Bank RG Premier Bank Scotiabank de Puerto Rico Western Federal Savings Bank Cooperataiva Empleados UPR Cooperativa Manuel Zeno Gandía First Federal Savings Bank First National Bank Boston Banco Santander de Puerto Rico Citibank Puerto Rico Eurobank &Trust Company Caribe Federal Credit Union Cooperativa La Puertorriqueña COOPACA There may be other financial institutions on the ACH system that are not included on the above list. 3. Credit transaction may be effective on date indicated by Río Piedras Campus to the financial institution It usually takes the financial institution between two or three working days to deposit payment on the account. Nevertheless, there may be special circumstances that can affect payment deposit by a financial institution. 4. No more checks lost in the mail. 5. There will be no charges related to direct deposit service. Contact: 1. If additional information is needed, please contact the Finance Office at 787-764-0000 x. 84360 or 787-764-1005 or by fax 787-763-6190.
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